Belmonte, Marta (2025) Computed Tomography for the Catheterization Laboratory: An Integrated Approach from Coronary to Structural Heart Disease. [Tesi di dottorato]

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Abstract

This PhD thesis investigates the expanding role of cardiovascular computed tomography (CT) as an integrated tool for guiding decision-making in the catheterization laboratory, spanning chronic coronary syndromes, structural heart interventions, and heart transplantation. By combining anatomical, functional, and prognostic insights, the work aims to improve diagnostic accuracy, optimize patient selection, and support personalized therapeutic strategies. In chronic coronary syndromes, coronary CT angiography (CCTA) is evaluated for detailed plaque characterization, identification of vulnerable atherosclerotic phenotypes, and prediction of functionally significant disease, with particular emphasis on the integration of CT-derived fractional flow reserve, stress myocardial CT perfusion, and virtual percutaneous coronary intervention planning. In the field of structural heart disease, the thesis explores CT applications in transcatheter aortic valve implantation, including myocardial tissue characterization through extracellular volume assessment, procedural planning, annular sizing, conduction disturbance prediction, and operator learning curves. Finally, in heart transplantation, CT is assessed as a comprehensive non-invasive alternative to invasive surveillance for cardiac allograft vasculopathy, incorporating novel biomarkers such as pericoronary fat attenuation to predict rejection and clinical outcomes, as well as analyses of healthcare resource utilization. Overall, this work highlights cardiovascular CT as a central, multipurpose modality capable of bridging anatomy, physiology, and clinical outcomes, reinforcing its pivotal role in contemporary interventional cardiology and precision cardiovascular medicine.

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